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Describe the location and function of the Proximal Convoluted Tubule.
Beginning part of nephron: reabsorbs 65% of Na+ and CL-, water follows the Na+ so it reabsorbs water as well.
Describe the location and function of the Loop of Henle.
Middle section of nephron; reabsorbs 20% of Na+ and Cl-
Describe the location and function of the Distal Convoluted Tubule. What hormone controls it?
End of nephron; DCT begins with the Early Distal which reabsorbs 10% of Na+ and Cl- / Ends with the Late Distal which reabsorbs ONLY the sodium (water follows) and excretes K+ under the effect of aldosterone.
Describe the location and function of the Collection Tubule. What hormone controls it?
At the end of the nephron after the DCT. It collects the waste to be voided. It also reabsorbs water under influence of ADH.
What is the MOA of a diuretic and what determines the level of effect?
- MOA: block Na+, Cl- and H20 reabsorption so we pee more
- Effect: caused by where in the nephron the diuretic takes effect. Drugs that affect on the Proximal tubule have the greatest reabsorptive power.
What are indications for diuretics?
- Edema and fluid overload
- Heart failure (reduces workload of heart by reducing volume)
What are some general side effects of diuretics?
- Electrolyte imbalance
Describe early signs of hypernatremia, hypokalemia, and hyperkalemia.
- Early signs:
- Hypernatremia: mental status changes (seizures late)
- Hypokalemia: U Wave, voluntary muscle weakness
- Hyperkalemia: stops heart
What are some general nursing considerations concerning volume and physical assessment when administering diuretics?
Assess Volume: the output should be greater than the input because we want to reduce volume so don't give them lots of water. Physical assessment; dry mucous membranes, edema, skin turgor: orthostatic vitals and postural changes (if BP drops over 20 and HR drops by over 20= took too much volume.)
Describe nursing considerations regarding electrolytes and nocturia when administering diuretics.
- Assess electrolye imbalances; look for early signs
- Dose in the AM to prevent nocturia. Nocturia is a leading cause of falls!!!
If someone on a diuretic loses 1 kg, how much fluid did they lose?
What type of drug is Mannitol and where does it has its effect?
What is the MOA of Mannitol?
It is a sugar that is not reabsorbed so it pulls fluid into the vessels by osmosis gradient. There is significant diuresis as it has an effect on the Proximal tubule.
What are three indications for Mannitol.
- Flush Kidneys (ex: nephrotoxic overdose)
- Intracranial hypertension and increased intraocular pressure (glaucoma) because it pulls the fluid from the brain into the vessels. It can't cross BBB.
Explain a major contraindication for Mannitol.
Heart failure: we want to decrease work load of heart during failure, so we want to decrease volume. Mannitol draws volume into the vessel, which increases the work load of the heart.
What is the route of administration for Mannitol?
What is the prototype Loop diuretic? What drug is it most similar to?
- Hydrochlorothiazide (HCTZ)
What are two indications for Furosemide? What route?
Hypertension and fluid overload; IV and oral
What type of pt is Furosemide good for that HCTZ is not? How do you remember it?
↓ glomerular filtration: Furosemide oh mide you're BUN is Hi(de). (IV route)
What drugs should you not take with Furosemide and HCTZ? Why?
"mycin" antibiotics and aminoglycosides because they are ototoxic and so is Furosemide. FurO-TOTOXIC
What giving Furosemide IV, what cranial nerve will it mess with?
CN VIII - that's why it's ototoxic
What part of the kidney does Hydrochlorothiazide (HCTZ) act on? Is it more/less potent than Furosemide?
Early Distal Tubule: less potent because diuretic acts on the Loop.
What type of diuretic is Spironolactone and where on the nephron does it act? How do you remember it?
Potassium sparing diuretic; late distal tubule. Spiro spares K+ lately.
What can high amounts of aldosterone do to the heart and vessels?
Make heart muscle fibrotic and vessels stiff.
What is the MOA of Spironolactone?
Inhibits aldosterone at the late distal tubule creating mild NA+ excretion/water excretion and substantial K+ reabsorption. Remember the Late distal tubule is under effect of aldosterone which usually keeps Na and excretes K+
What effect does Spironolactone have on pts with CHF? How does it do it?
Reduces morbidity and mortality by blocking aldosterone receptors on the heart and blood vessels.
Why is Spironolactone given with furosemide and/or HCTZ?
To offset my hypokalemia
What is hirsutism and gynomastia. What diuretic can cause these and why?
- Hirsutism: hairy women
- Gynomastia: man boobs
- Spironolactone; it is chemically similar to estrogen and testosterone
How do you remember that Spironolactone causes hirsutism and gynomastia?
Although Spironolactone spares K+ in the late distal tubule, it can cause man boobs and hairy women.
List a high-ceiling loop diuretic.
List a thiazide diuretic. What part of nephron?
HCTZ (hydrochlorothiazide): early distal tubule
List a potassium-sparing diuretic.
List an osmotic diuretic.
What is the trade name for furosemide?
When are high ceiling loop diuretics used? Name one.
Furosemide (Lasik) is used when there is an emergent need for rapid mobilization of fluid such as pulmonary edema and edema caused by liver, cardiac or kidney disease or hypertension
What type of allergy could stop you from administering thiazide drugs like HCTZ?
sulfa allergies because thiazides have sulfa allergies
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